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Hua M, Guo L, Ing C, Lackraj D, Wang S, Morrison RS. Specialist Palliative Care Use and End-of-Life Care in Patients With Metastatic Cancer. J Pain Symptom Manage 2024; 67:357-365.e15. [PMID: 38278187 PMCID: PMC11032225 DOI: 10.1016/j.jpainsymman.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
CONTEXT For patients with advanced cancer, high intensity treatment at the end of life is measured as a reflection of the quality of care. Use of specialist palliative care has been promoted to improve care quality, but whether its use is associated with decreased treatment intensity on a population-level is unknown. OBJECTIVES To determine whether receipt of specialist palliative care use is associated with differences in end-of-life quality metrics in patients with metastatic cancer. METHODS Retrospective propensity-matched cohort of patients age ≥ 65 who died with metastatic cancer in U.S. hospitals with palliative care programs that participated in the National Palliative Care Registry in 2018-2019. Cox proportional hazards regression was used to assess the impact of specialist palliative care on use of chemotherapy in the last 14 days of life, use of intensive care unit (ICU) in the last 30 days of life, use of hospice, and hospice enrollment ≥ three days. RESULTS After 1:2 matching, our cohort consisted of 15,878 exposed and 31,756 unexposed patients. Receipt of specialist palliative care was associated with a decrease in use of chemotherapy (adjusted hazard ratio (aHR) 0.59 [0.50-0.70]) and ICU at the end of life (aHR 0.86 [0.80-0.92]), and an increase in hospice use (aHR 1.92 [1.85-1.99]) and hospice enrollment for ≥three days (aHR 2.00 [1.93-2.07]). CONCLUSION On a population-level, use of specialist palliative care was associated with improved metrics for quality end-of-life care for patients dying with metastatic cancer, underscoring the importance of its integration into cancer care.
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Affiliation(s)
- May Hua
- Department of Anesthesiology (M.H., C.I.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
| | - Ling Guo
- Department of Anesthesiology (L.G.), College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Caleb Ing
- Department of Anesthesiology (M.H., C.I.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Deven Lackraj
- Department of Anesthesiology (D.L.), Columbia University College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Shuang Wang
- Department of Biostatistics (S.W.), Mailman School of Public Health, Columbia University, New York, New York, USA
| | - R Sean Morrison
- Icahn School of Medicine at Mount Sinai and James J Peters VA (R.S.M.), Bronx, New York, USA
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2
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Xu N, Sun BJ, Yue TM, Lee B. Factors Predicting Readmission and Mortality in Patients Admitted for Malignant Bowel Obstruction. Am Surg 2024:31348241250045. [PMID: 38676624 DOI: 10.1177/00031348241250045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Malignant bowel obstruction (MBO) is a common complication of patients with advanced malignancies and has poor prognosis. Currently, there are limited guidelines for MBO management or predicting outcomes for these patients. OBJECTIVE To identify patient factors associated with readmission and mortality after hospital admission for MBO. PARTICIPANTS A 5-year retrospective review was performed from 2017 to 2022 at a single tertiary institution to evaluate patients admitted for MBO. All patients had advanced cancer of gastrointestinal or gynecologic primary. Patient demographics, socioeconomic factors, tumor characteristics, and inpatient outcomes were collected. Multivariable analyses were performed to determine variables predicting hospital readmission for recurrent MBO and 90-day mortality. RESULTS 210 patients were included. Mean age was 61 years, 28% were male, and 19% did not primarily speak English. 35% of patients lived over 50 miles from the hospital. On multivariable analysis, non-English speaking patients exhibited increased risk of readmission for MBO (OR = 2.82, P = .039). Older age was associated with decreased risk for MBO readmission (OR = .96, P = .007). Ascites was associated with increased mortality (OR = 2.17, P = .043). Earlier palliative care (PC) consultation predicted decreased readmission (OR = .24, P < .001) yet increased mortality at 90 days (OR = 3.20, P = .003). CONCLUSION Patient age, primary language, and PC consult were predictors for MBO readmission, which may impact 90-day mortality. Given the palliative nature of MBO, modifiable factors such as PC consultation and multidisciplinary goals of care discussions should be prioritized in order to reduce readmissions and focus on quality of life (QOL) for this patient population.
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Affiliation(s)
- Nova Xu
- Stanford University School of Medicine, Stanford, CA, USA
| | - Beatrice J Sun
- Section of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Tiffany M Yue
- Stanford University School of Medicine, Stanford, CA, USA
| | - Byrne Lee
- Section of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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3
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Khayal IS, O'Malley AJ, Barnato AE. Clinically informed machine learning elucidates the shape of hospice racial disparities within hospitals. NPJ Digit Med 2023; 6:190. [PMID: 37828119 PMCID: PMC10570342 DOI: 10.1038/s41746-023-00925-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023] Open
Abstract
Racial disparities in hospice care are well documented for patients with cancer, but the existence, direction, and extent of disparity findings are contradictory across the literature. Current methods to identify racial disparities aggregate data to produce single-value quality measures that exclude important patient quality elements and, consequently, lack information to identify actionable equity improvement insights. Our goal was to develop an explainable machine learning approach that elucidates healthcare disparities and provides more actionable quality improvement information. We infused clinical information with engineering systems modeling and data science to develop a time-by-utilization profile per patient group at each hospital using US Medicare hospice utilization data for a cohort of patients with advanced (poor-prognosis) cancer that died April-December 2016. We calculated the difference between group profiles for people of color and white people to identify racial disparity signatures. Using machine learning, we clustered racial disparity signatures across hospitals and compared these clusters to classic quality measures and hospital characteristics. With 45,125 patients across 362 hospitals, we identified 7 clusters; 4 clusters (n = 190 hospitals) showed more hospice utilization by people of color than white people, 2 clusters (n = 106) showed more hospice utilization by white people than people of color, and 1 cluster (n = 66) showed no difference. Within-hospital racial disparity behaviors cannot be predicted from quality measures, showing how the true shape of disparities can be distorted through the lens of quality measures. This approach elucidates the shape of hospice racial disparities algorithmically from the same data used to calculate quality measures.
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Affiliation(s)
- Inas S Khayal
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756, USA.
- Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756, USA.
- Department of Computer Science, Dartmouth College, Hanover, NH, 03755, USA.
- Cancer Population Sciences Program, Norris Cotton Cancer Center, Lebanon, NH, 03756, USA.
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756, USA
- Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756, USA
- Department of Computer Science, Dartmouth College, Hanover, NH, 03755, USA
- Department of Mathematics, Dartmouth College, Hanover, NH, 03755, USA
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756, USA
- Cancer Population Sciences Program, Norris Cotton Cancer Center, Lebanon, NH, 03756, USA
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA
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4
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Tseng Y, Lin Y, Hsu W, Kang Y, Su H, Cheng S, Tsai J, Chiu T, Huang H. Shared decision making with Oncologists and Palliative care specialists (SOP) model help advanced pancreatic cancer patients reaching goal concordant care: A prospective cohort study. Cancer Med 2023; 12:20119-20128. [PMID: 37740620 PMCID: PMC10587919 DOI: 10.1002/cam4.6590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Pancreatic cancer is often diagnosed at a late stage with a poor prognosis due to insidious symptoms and lack of evidence-based screening in general population. Palliative care's acceptance in Asian cultures is hindered by misconceptions and ineffective communication about management that improve quality of life other than cancer directed treatment. Our study aimed to determine the effect of the Shared decision-making with Oncologists and Palliative care specialists (SOP) model developed from the traditional shared decision-making (SDM) model on the palliative care acceptance rate and medical resource utilization. METHODS This is a prospective cohort study implementing the SOP model at the National Taiwan University Hospital from January 2018 to December 2019 for patients with advanced pancreatic cancer. Medical resource utilization was defined and recorded as the rate of hospitalization, emergency room (ER), and intensive care unit admissions. We compared the results between two groups: patients who received the SOP model in 2019 and patients who did not receive it in 2018. RESULTS 137 patients with advanced pancreatic cancer were included in our study. The result showed that the acceptance rate of palliative care significantly increased from 50% to 78.69% after the SOP model (p = 0.01). The hospitalization rate did not show a significant difference between 2018 (93.42%, 95% CI: 0.88-0.99) and 2019 (93.44%, 95% CI: 0.87-1.00). 83.61% (95% CI: 0.74-0.93) of our patients in 2019 had at least one ER visit; the rate was 81.5% (95% CI: 0.73-0.91) in 2018 (p = 0.28). The percentage of patients admitted to the ICU increased from 3.95% in 2018 to 8.2% (95% CI: -0.05-0.08) in 2019 (95% CI: 0.11-0.15) (p = 0.00). The hospitalization and ER visit showed no statistically difference between 2 years. CONCLUSIONS The modified SOP model markedly augmented palliative care's acceptance of patients with advanced pancreatic cancer. Adoption of the SOP model would provide these patients a more proactive and systematic approach to deliver needed healthcare.
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Affiliation(s)
- Yung‐Ling Tseng
- Department of EducationKuang Tien General HospitalTaichungTaiwan
| | - Yun‐Ching Lin
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
| | - Wan‐Ju Hsu
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
- Department of NursingNational Taiwan University HospitalTaipei cityTaiwan
| | - Ya‐Chun Kang
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
| | - Hsin‐Yin Su
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
| | - Shao‐Yi Cheng
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
| | - Jaw‐Shiun Tsai
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
| | - Tai‐Yuan Chiu
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
| | - Hsien‐Liang Huang
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
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van Doorne I, de Meij MA, Parlevliet JL, van Schie VMW, Willems DL, Buurman BM, van Rijn M. More older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life: a before-after study. BMC Palliat Care 2023; 22:110. [PMID: 37533107 PMCID: PMC10394846 DOI: 10.1186/s12904-023-01218-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND To improve transmural palliative care for older adults acutely admitted to hospital, the PalliSupport intervention, comprising an educational programme and transmural palliative care pathway, was developed. This care pathway involves timely identification of palliative care needs, advance care planning, multidisciplinary team meetings, warm handover, and follow-up home visits. With this study, we evaluate changes in patient-related outcomes and transmural collaboration after implementation of the care pathway. METHODS We conducted a before-after study, in which we compared 1) unplanned hospital admission and death at place of preference and 2) transmural collaboration before implementation, up to six months, and six to 18 months after implementation. Data from palliative care team consultations were collected between February 2017 and February 2020 in a teaching hospital in the Netherlands. RESULTS The palliative care team held 711 first-time consultations. The number of consultation, as well as the number of consultations for patients with non-malignant diseases, and consultations for advance care planning increased after implementation. The implementation of the pathway had no statistically significant effect on unplanned hospitalization but associated positively with death at place of preference more than six months after implementation (during/shortly after adjusted OR: 2.12; 95% CI: 0.84-5.35; p-value: 0.11, long term after adjusted OR: 3.14; 95% CI: 1.49-6.62; p-value: 0.003). Effects on transmural collaboration showed that there were more warm handovers during/shortly after implementation, but not on long term. Primary care professionals attended multidisciplinary team meetings more often during and shortly after implementation, but did not more than six months after implementation. CONCLUSIONS The pathway did not affect unplanned hospital admissions, but more patients died at their place of preference after implementation. Implementation of the pathway increased attention to- and awareness for in-hospital palliative care, but did not improve transmural collaboration on long-term. For some patients, the hospital admissions might helped in facilitating death at place of preference.
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Affiliation(s)
- Iris van Doorne
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Room D3-335, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands.
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands.
| | - Marike A de Meij
- Palliative and Supportive Care Team, Oncology Center Amsterdam, OLVG, Oosterpark 9, Amsterdam, The Netherlands
| | - Juliette L Parlevliet
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Room D3-335, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Vera M W van Schie
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Room D3-335, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Dick L Willems
- General Practice, Section of Medical Ethics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Room D3-335, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Boelelaan 1117, Amsterdam, The Netherlands
| | - Marjon van Rijn
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Room D3-335, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Boelelaan 1117, Amsterdam, The Netherlands
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6
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Association between inpatient palliative care encounter and 30-day all-cause readmissions after index hospitalization for chronic obstructive pulmonary disease. Heart Lung 2023; 58:69-73. [PMID: 36410155 DOI: 10.1016/j.hrtlng.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies exist on the association between inpatient Palliative Care Encounter (iPCE) and 30-day rehospitalization among cancer and several non-cancer conditions but limited in persons with Chronic Obstructive Pulmonary Disease (COPD). OBJECTIVE To assess the association between an iPCE with the risk of 30-day rehospitalization after an index hospitalization for COPD. METHODS We conducted a cross-sectional analysis of the Nationwide Readmissions Database (2010-2014). Index hospitalizations were defined as persons ≥ 18 years of age, discharge destinations of either Home/Routine, Home with Home Care, or a Facility, and an index hospitalization with Diagnosis Related Group of COPD. The International Classification of Diseases, 9th revision codes were used to extract comorbidities and a Palliative Care Encounter (V66.7). RESULTS There were 3,163,889 index hospitalizations and iPCE occurred in 21,330 (0.67%). There were 558,059 (17.63%) with a 30-day rehospitalization. An iPCE was associated with a significantly lower adjusted odds of 30-day readmission (Odds Ratio [OR], 0.50; 95% Confidence Interval [CI], 0.46 to 0.54). By discharge destination, the odds of 30-day rehospitalization were for a discharged to a facility (OR, 0.37; 95% CI, 0.32 to 0.42), to home with home health (OR, 0.42; 95% CI, 0.37 to 0.47), and to home (OR, 0.98; 95% CI, 0.85 to 1.12) for those with relative to without iPCE. CONCLUSION Inpatient PCE was associated with a 50% lower relative odds of 30-day rehospitalization after an index hospitalization for COPD. This association varied by discharge destination being statistically significant among those with a discharge destination of a facility (63%) and home with home care (58%).
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7
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Im JH, Chow R, Novosel M, Xiang J, Strait M, Rao V, Kapo J, Zimmermann C, Prsic E. Association of palliative care and hospital outcomes among solid tumour oncology inpatients. BMJ Support Palliat Care 2023:spcare-2023-004207. [PMID: 36849221 DOI: 10.1136/spcare-2023-004207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES We aimed to explore the association between receiving an inpatient palliative care consultation and hospital outcomes, including in-hospital death, intensive care unit (ICU) use, discharge to hospice, 30-day readmissions and 30-day emergency department (ED) visits. METHODS We conducted a retrospective chart review of Yale New Haven Hospital medical oncology admissions from January 2018 through December 2021, with and without inpatient palliative care consultations. Hospital outcome data were extracted from medical records and operationalised as binary. Multivariable logistic regression was used to estimate ORs for the association between number of inpatient palliative care consultations and hospital outcomes. RESULTS Our sample included 19 422 patients. Age, Rothman Index, site of malignancy, length of stay, discharge to hospice, ICU admissions, hospital death and readmissions within 30 days differed significantly between patients who received versus did not receive a palliative care consultation. On multivariable analysis, receiving one additional palliative care consultation was significantly associated with higher odds of hospital death (adjusted OR=1.15, 95% CI 1.12 to 1.17) and discharge to hospice (adjusted OR = 1.23, 95% CI 1.20 to 1.26), and lower odds of ICU admission (adjusted OR=0.94, 95% CI 0.92 to 0.97). There was no significant association between palliative care consultations and readmission within 30 days or with ED visits within 30 days. CONCLUSION Inpatients receiving palliative care had increased likelihood of hospital death. However, when controlling for significant differences in patient presentation, patients had nearly 25% greater odds of discharge to hospice and less odds to transition to ICU level of care.
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Affiliation(s)
- James Hb Im
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Ronald Chow
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madison Novosel
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Jenny Xiang
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Michael Strait
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Vinay Rao
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Jennifer Kapo
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Camilla Zimmermann
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Prsic
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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8
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Han HJ, Yeh JC, McNichol M, Buss MK. Delivering Palliative Care to Hospitalized Oncology Patients: A Scoping Review. J Pain Symptom Manage 2023; 65:e137-e153. [PMID: 36243248 DOI: 10.1016/j.jpainsymman.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Early, longitudinal integration of palliative care (PC) is recommended for patients with advanced cancer, in both inpatient and outpatient settings. Despite the growth of specialty PC teams in the last decade, the majority of PC is still delivered in the inpatient setting using a traditional referral-based consult delivery model. However, traditional consultation can lead to significant variation or delay in inpatient PC utilization. New care delivery models and strategies are emerging to deliver PC to hospitalized oncology patients who would most benefit from their services and to better align with professional society recommendations. OBJECTIVES To identify different care models to deliver PC to ho`spitalized oncology patients and summarize their impact on patient and health system-related outcomes. METHODS We conducted a scoping review of peer-reviewed articles from 2006 to 2021 evaluating delivery of PC to oncology patients in acute inpatient care. We abstracted study characteristics, the study's intervention and comparison arms, and outcomes related to specialty PC intervention. RESULTS We identified four delivery models that have been reported to deliver PC: 1) traditional referral-based consultation, 2) criterion-based or "triggered" consultation, 3) co-rounding with primary inpatient team, and 4) PC clinicians serving as the primary team. We summarize the known outcomes data from each model, and compare the benefits and limitations of each model. CONCLUSION Our findings provide guidance to health systems about care delivery models to deploy and implement inpatient PC resources to best serve their unique populations.
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Affiliation(s)
- Harry J Han
- Section of Palliative Care, Division of General Medicine and Primary Care (H.J.H., J.C.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Jonathan C Yeh
- Section of Palliative Care, Division of General Medicine and Primary Care (H.J.H., J.C.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan McNichol
- Division of Knowledge Services, Department of Information Services (M.M.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mary K Buss
- Division of Palliative Care, Department of Medicine (M.K.B.), Tufts University School of Medicine, Boston, Massachusetts, USA
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9
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What are the outcomes of hospice care for cancer patients? A systematic review. Support Care Cancer 2023; 31:64. [DOI: 10.1007/s00520-022-07524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/12/2022] [Indexed: 12/24/2022]
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10
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Parast L, Tolpadi AA, Teno JM, Elliott MN, Price RA. Hospice Care Experiences Among Cancer Patients and Their Caregivers. J Gen Intern Med 2021; 36:961-969. [PMID: 33469741 PMCID: PMC8042100 DOI: 10.1007/s11606-020-06490-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the current quality of care for hospice cancer patients and how it varies across hospice programs in the USA. OBJECTIVE To examine hospice care experiences among decedents with a primary cancer diagnosis and their family caregivers, comparing quality across settings of hospice care. DESIGN We analyzed data from the Consumer Assessment of Healthcare Providers and Systems Hospice Survey (32% response rate). Top-box outcomes (0-100) were calculated overall and by care setting, adjusting for survey mode and patient case mix. PARTICIPANTS Two hundred seventeen thousand five hundred ninety-six caregiver respondents whose family member had a primary cancer diagnosis and died in 2017 or 2018 while receiving hospice care from 2,890 hospices nationwide. MAIN MEASURES Outcomes (0-100 scale) included 8 National Quality Forum-endorsed quality measures, as well as responses to 4 survey questions assessing whether needs were met for specific symptoms (pain, dyspnea, constipation, anxiety/sadness). KEY RESULTS Quality measure scores ranged from 74.9 (Getting Hospice Care Training measure) to 89.5 (Treating Family Member with Respect measure). The overall score for Getting Help for Symptoms was 75.1 with item scores within this measure ranging from 60.6 (getting needed help for feelings of anxiety or sadness) to 84.5 (getting needed help for pain). Measure scores varied significantly across settings and differences were large in magnitude, with caregivers of decedents who received care in a nursing home (NH) or assisted living facility (ALF) setting consistently reporting poorer quality of care. CONCLUSIONS Important opportunities exist to improve hospice care for symptom palliation and providing training for caregivers when their family members are at home or in an ALF setting. Efforts to improve care for cancer patients in the NH and ALF setting are especially needed.
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Affiliation(s)
| | | | - Joan M Teno
- Oregon Health & Science University, Portland, OR, USA
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11
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Kadu M, Mondor L, Hsu A, Webber C, Howard M, Tanuseputro P. Does Inpatient Palliative Care Facilitate Home-Based Palliative Care Postdischarge? A Retrospective Cohort Study. Palliat Med Rep 2021; 2:25-33. [PMID: 34223500 PMCID: PMC8241378 DOI: 10.1089/pmr.2020.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Evidence of the impact of inpatient palliative care on receiving home-based palliative care remains limited. Objectives: The objective of this study was to examine, at a population level, the association between receiving inpatient palliative care and home-based palliative care postdischarge. Design: We conducted a retrospective cohort study to examine the association between receiving inpatient palliative care and home-based palliative care within 21 days of hospital discharge among decedents in the last six months of life. Setting/Subjects: We captured all decedents who were discharged alive from an acute care hospital in their last 180 days of life between April 1, 2014, and March 31, 2017, in Ontario, Canada. The index event was the first hospital discharge furthest away from death (i.e., closest to 180 days before death). Results: Decedents who had inpatient palliative care were significantly more likely to receive home-based palliative care after discharge (80.0% vs. 20.1%; p < 0.001). After adjusting for sociodemographic and clinical covariates, the odds of receiving home-based palliative care were 11.3 times higher for those with inpatient palliative care (95% confidence interval [CI]: 9.4–13.5; p < 0.001). The strength of the association incrementally decreased as death approached. The odds of receiving home-based palliative care after a hospital discharge 60 days before death were 7.7 times greater for those who received inpatient palliative care (95% CI: 6.0–9.8). Conclusion: Inpatient palliative care offers a distinct opportunity to improve transitional care between hospital and home, through enhancing access to home-based palliative care.
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Affiliation(s)
- Mudathira Kadu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Luke Mondor
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Amy Hsu
- Bruyère Research Institute, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Colleen Webber
- Bruyère Research Institute, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michelle Howard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Peter Tanuseputro
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Cross SH, Lakin JR, Mendu M, Mandel EI, Warraich HJ. Trends in Place of Death for Individuals With Deaths Attributed to Advanced Chronic or End-Stage Kidney Disease in the United States. J Pain Symptom Manage 2021; 61:112-120.e1. [PMID: 32791183 DOI: 10.1016/j.jpainsymman.2020.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/29/2020] [Accepted: 08/05/2020] [Indexed: 12/30/2022]
Abstract
CONTEXT An important aspect of end-of-life care, place of death is understudied in advanced chronic (CKD) and end-stage kidney disease (ESKD). OBJECTIVE We sought to examine trends and factors associated with where advanced CKD/ESKD patients die. METHODS We conducted a retrospective cross-sectional study using mortality data from 2003 to 2017 for deaths attributed primarily to advanced CKD/ESKD in the United States. RESULTS Between 2003 and 2017, 222,247 deaths were attributed to advanced CKD/ESKD. From 2003 to 2017, deaths occurring in hospitals declined from 56.0% (n = 5356) to 35.6% (n = 7764), whereas increases occurred in deaths at home (13.5% [n = 1292] to 24.3% [n = 5306]), nursing facilities (18.6% [n = 1776] to 19.3% [n = 4221]), and hospice facilities (0.3% [n = 29] to 13.4% [n = 2917]). Nonwhite race was associated with increased odds of hospital death (Black [OR = 1.59; 95% CI = 1.55, 1.62]; Native American [OR = 1.47; 95% CI = 1.32, 1.63]; Asian [OR = 1.43; 95% CI = 1.32, 1.55] and reduced odds of nursing facility (Black [OR = 0.622; 95% CI = 0.600, 0.645]; Native American [OR = 0.638; 95% CI = 0.572, 0.712]; Asian [OR = 0.574; 95% CI = 0.533, 0.619], or hospice facility death (Black [OR = 0.843; 95% CI = 0.773, 0.918]; Native American [OR = 0.380; 95% CI = 0.289, 0.500]; Asian [OR = 0.609; 95% CI = 0.502, 0.739]). Older age was associated with reduced odds of hospital death (≥85 [OR = 0.334; 95% CI = 0.312, 0.358]) and increased odds of home (≥85 [OR = 1.55; 95% CI = 1.43, 1.68]), nursing facility (≥85 [OR = 3.09; 95% CI = 2.76, 3.45]) or hospice facility death (≥85 [OR = 1.60; 95% CI = 1.49, 1.72]). CONCLUSIONS Hospitals remain the most common place of death from advanced CKD/ESKD; however, the proportion of home, nursing facility, and hospice facility deaths have increased.
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Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA.
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Mallika Mendu
- Harvard Medical School, Boston, Massachusetts, USA; Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ernest I Mandel
- Harvard Medical School, Boston, Massachusetts, USA; Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Haider J Warraich
- Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiology Section, Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts, USA
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13
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Webber C, Chan R, Scott M, Brown C, Spruin S, Hsu AT, Bush SH, Isenberg SR, Quinn K, Scott J, Tanuseputro P. Delivery of Palliative Care in Acute Care Hospitals: A Population-Based Retrospective Cohort Study Describing the Level of Involvement and Timing of Inpatient Palliative Care in the Last Year of Life. J Palliat Med 2020; 24:1000-1010. [PMID: 33337265 DOI: 10.1089/jpm.2020.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Much end-of-life care is provided in hospital, yet little is known about the delivery of palliative care during end-of-life hospitalizations. Objectives: To characterize the level of palliative care involvement across hospitalizations in the last year of life. Methods: A population-based retrospective cohort study of adults in Ontario, Canada, who died between April 1, 2012, and March 31, 2017, and had at least one acute care hospitalization in their last year of life. Using linked administrative health data, we developed a hierarchy of inpatient palliative care involvement reflecting the degree to which care was delivered with palliative intent. This hierarchy was based on palliative care diagnosis and service provider codes on hospitalization records and physician claims. We examined variations in the level of palliative care involvement across key patient characteristics. Results: In the last year of life, 65.1% of hospitalizations had no indication of palliative care involvement, 16.7% had a low level of involvement, 13.5% had a medium level of involvement, and 4.7% had a high level of involvement. Most hospitalizations with palliative care involvement (85.6%) occurred in the two months before death. Compared to patients who received no inpatient palliative care, patients who received a high level of palliative care involvement tended to be younger, died of cancer, resided in urban or lower income neighborhoods, and had fewer chronic conditions. Discussion: While many hospitalizations occurred in the last year of life, the majority did not involve palliative care, and very few had a high level of palliative care involvement.
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Affiliation(s)
- Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Raphael Chan
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Scott
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Catherine Brown
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Spruin
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa, Ontario, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarina R Isenberg
- Temmy Latner Centre for Palliative Care and Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Department of Family and Community Medicine and University of Toronto, Toronto, Ontario, Canada
| | - Kieran Quinn
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John Scott
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
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14
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Spencer KL, Mrig EH, Talaie AK. Does Palliative Care Utilization Facilitate Conversion to Hospice Care? A Qualitative Study of the "Soft No". Am J Hosp Palliat Care 2020; 37:701-706. [PMID: 31968990 DOI: 10.1177/1049909119900640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Facilitating patient conversion to hospice at end of life is a prominent clinical concern. Enrollment in outpatient palliative care services is often assumed to encourage seamless transition to hospice care, but this has not been demonstrated. Moreover, decisions to convert from palliative care to hospice are generally treated as dichotomous, thus hampering our ability to understand decision processes. OBJECTIVE To examine medical decision-making among patients who are prospectively evaluating whether to convert from palliative care to hospice. DESIGN Qualitative case study, using in-depth interviews and constant comparative method. SETTING/PATIENTS Terminally ill patients currently enrolled in outpatient palliative care services (N = 26) and their caregivers (N = 16), selected purposely for maximum variation in condition and personal background. MEASUREMENTS Themes identified in qualitative in-depth interviews. RESULTS Patients rarely refused hospice outright but more often postponed using a "soft no," in which they neither accepted nor overtly refused hospice. Justifications patients and caregivers offered for why hospice was not needed (yet) appeared in these themes: (1) not seeing the value added of hospice, (2) assuming the timing is premature, and (3) relying on extensive health-related support networks that justify or endorse continuation of active care. CONCLUSIONS Despite assumptions to the contrary, benefits associated with utilization of outpatient palliative care services have the potential to incentivize the delay of hospice in some cases. Clinical interactions with outpatient palliative care patients should consider the influence of these broad social support systems when discussing hospice options.
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Affiliation(s)
- Karen Lutfey Spencer
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
| | - Emily Hammad Mrig
- Department of Health Policy and Management, Yale University, New Haven, CO, USA
| | - Ariana Kobra Talaie
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
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15
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Scott M, Shaver N, Lapenskie J, Isenberg SR, Saunders S, Hsu AT, Tanuseputro P. Does inpatient palliative care consultation impact outcomes following hospital discharge? A narrative systematic review. Palliat Med 2020; 34:5-15. [PMID: 31581888 DOI: 10.1177/0269216319870649] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While most patients desire to die at home or in a community-based hospice, the transition from hospital to community settings often lacks streamlined coordination of care to ensure that adequate support is provided in the preferred care setting. The impact of hospital-based palliative care consultations on post-discharge care and outcomes has not been extensively studied. AIM The aim of this study was to appraise available research on the impact of inpatient palliative care consultations on transitions from hospital to community settings. DESIGN We conducted a narrative systematic review and used the Effective Public Health Practice Project tool to appraise the quality of selected studies. Studies were included if they assessed the transition from hospital to community and examined outcomes after an inpatient palliative care consultation. A protocol for this study was registered and published in PROSPERO, Centre for Reviews and Dissemination (ID: CRD42018094924). DATA SOURCES We searched for quantitative studies indexed in PubMED, CINAHL and Cochrane and published between 1 January 1 2000 and 11 March 2018. RESULTS Our search retrieved 2749 articles. From these, 123 articles were full-text screened and 15 studies met our inclusion criteria. Studies reported that inpatient palliative care consultations are associated with high rates of discharge to community settings, greater provision of services post-discharge, improved coordination and lower rates of rehospitalization. CONCLUSION Existing evidence suggest that inpatient palliative care consultations have a positive impact on patient outcomes and transitions to the community, demonstrating the potential to improve patient quality of life and relieve overburdened acute care systems.
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Affiliation(s)
- Mary Scott
- Bruyère Research Institute, Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Julie Lapenskie
- Bruyère Research Institute, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sarina R Isenberg
- Temmy Latner Centre for Palliative Care and Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Saunders
- Temmy Latner Centre for Palliative Care and Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Amy T Hsu
- Bruyère Research Institute, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Bruyère Research Institute, Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Loh KP, Abdallah M, Shieh MS, Stefan MS, Pekow PS, Lindenauer PK, Mohile SG, Babu D, Lagu T. Use of Inpatient Palliative Care Services in Patients With Advanced Cancer Receiving Critical Care Therapies. J Natl Compr Canc Netw 2019; 16:1055-1064. [PMID: 30181417 DOI: 10.6004/jnccn.2018.7039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/26/2018] [Indexed: 01/03/2023]
Abstract
Background: Invasive mechanical ventilation (IMV), dialysis for acute kidney failure, and other critical care therapies (CCTs) are associated with a high risk for complications in patients with metastatic cancer. Inpatient palliative care (IPC) can assist in assessing patients' preferences for life-prolonging treatment at the end of life. This study investigated the use pattern of IPC, outcomes (in-hospital mortality, length of stay [LOS], discharge destination, and cost of care), and predictors of IPC use in patients with metastatic cancer who received CCTs. We hypothesized that IPC services are underused in this cohort. Methods: In this retrospective cohort study, we used the 2010 California State Inpatient Databases to identify adults with metastatic cancer who received CCTs that are common and reliably coded (IMV, tracheostomy, percutaneous endoscopic gastrostomy tube, dialysis for acute kidney failure, and total parenteral nutrition). We determined IPC use in all patients, in those who received IMV, and across 4 cancer subtypes (lung, breast, colorectal, and genitourinary). Outcomes were assessed based on IPC use. Multivariable analyses were used to investigate factors associated with IPC use. Results: We identified 5,862 hospitalizations, 19.8% of which used IPC services. IPC use varied across cancer subtypes (lung, 28.3%; breast, 22.4%; colorectal, 12.8%; genitourinary, 16.1%; P<.01). Patients who received and did not receive IPC services had high in-hospital mortality rates (63.9% and 29.8%, respectively), and costs of care and LOS were lower in survivors who received IPC compared with those who did not. Predictors of IPC use were lung cancer (vs colorectal or genitourinary cancer), higher comorbidity score, do-not-resuscitate status on admission or within 24 hours of admission, infections (vs cancer-related diagnoses), and higher hospital bed count. Conclusions: Use of IPC was low in the cohort who received CCTs with poor outcomes, although data on outpatient palliative care services is lacking. Predictors of IPC use may be used to identify patients who may benefit from these services.
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17
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Cao T, Johnson A, Coogle J, Zuzelski A, Fitzgerald S, Kapadia V, Stoltzfus K. Incidence and Characteristics Associated with Hospital Readmission after Discharge to Home Hospice. J Palliat Med 2019; 23:233-239. [PMID: 31513454 DOI: 10.1089/jpm.2019.0246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Home hospice is designed to provide comfort to patients at the end of their life and hospital readmission is incongruent with this goal. Objective: The purpose of this study was to investigate the incidence of and characteristics associated with hospital readmissions from home hospice over a two-year period. Design/Subjects: This was a retrospective cohort study of 705 inpatients discharged from a quaternary academic medical center to home hospice from January 1, 2016 to December 31, 2017. Measures: The primary outcome was incidence of hospital readmission after discharge to home hospice. Multivariate regression with stepwise forward selection was used to identify characteristics associated with readmission. Results: The incidence of readmission was found to be 10.50% (n = 74), and the median days from discharge to readmission were 32.50 days (interquartile range = 14.00, 75.00). Reasons for readmission were: unanticipated new medical issue (n = 33, 44.59%), uncontrolled symptoms (n = 25, 33.78%), misunderstanding of hospice status (n = 12, 16.22%), and caregiver distress (n = 4, 5.41%). The following characteristics were associated with readmission: female versus male (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 1.16-3.32), non-white versus white (OR = 2.40; 95% CI: 1.36-4.24), and hospice diagnosis of cardiac disease versus all other diagnoses (OR = 4.40; 95% CI: 2.06-9.37). Conclusions: Compared with prior studies, our findings showed a lower incidence of readmission, 10.50%, from home hospice. In addition, those who are female, non-white, or have a hospice diagnosis of cardiac disease are more likely to be readmitted.
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Affiliation(s)
- Thuy Cao
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Amy Johnson
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Justin Coogle
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Adam Zuzelski
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Sharon Fitzgerald
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas
| | - Vishal Kapadia
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Ky Stoltzfus
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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18
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Lasater KB, Sloane DM, McHugh MD, Aiken LH. Quality of End-of-Life Care and Its Association with Nurse Practice Environments in U.S. Hospitals. J Am Geriatr Soc 2019; 67:302-308. [PMID: 30506666 PMCID: PMC6367037 DOI: 10.1111/jgs.15671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The purpose of this study is twofold: (1) to describe the quality of end-of-life care in US hospitals from the perspective of hospital nurses; and (2) to evaluate the relationship between the nurse practice environment and end-of-life care quality. DESIGN Cross-sectional analysis of multiple linked secondary data sources. PARTICIPANTS AND SETTING A total of 12,870 direct care registered nurses in 491 acute-care hospitals. MEASUREMENTS Measures of end-of-life care quality and nurse practice environment were derived from the 2016 RN4CAST-US survey of nurses. Nurses reported on end-of-life care quality for patients for whom death within a year would not be surprising. Nurse practice environment was measured using the Practice Environment Scale of the Nursing Work Index, a National Quality Forum validated scale. RESULTS Most nurses gave their hospitals an unfavorable evaluation of end-of-life care overall (58%) and said patients often experience painful procedures that were unlikely to change their outcome (53%). The best predictor of poor quality was the nurse practice environment. Nurses in the best environments were 55% less likely than nurses in poor environments to rate their hospital's overall end-of-life care quality unfavorably (odds ratio = 0.45; 95% confidence interval = 0.39-0.52; P < .001). CONCLUSION Quality of end-of-life care in US hospitals is imperfect and is significantly worse in hospitals with poor nurse practice environments than in hospitals with the best environments. This study reinforces the importance of nurses in providing high-quality end-of-life care. J Am Geriatr Soc 67:302-308, 2019.
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Affiliation(s)
- Karen B. Lasater
- Assistant Professor of Nursing, Senior Fellow, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
| | - Douglas M. Sloane
- Adjunct Professor of Nursing, Senior Fellow, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
| | - Matthew D. McHugh
- The Independence Chair for Nursing Education Professor of Nursing Associate Director, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
| | - Linda H. Aiken
- Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology, School of Arts and Sciences, Director, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania
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Park SJ, Nam EJ, Chang YJ, Lee YJ, Jho HJ. Factors Related with Utilizing Hospice Palliative Care Unit among Terminal Cancer Patients in Korea between 2010 and 2014: a Single Institution Study. J Korean Med Sci 2018; 33:e263. [PMID: 30288159 PMCID: PMC6170669 DOI: 10.3346/jkms.2018.33.e263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 07/13/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Establishing and designating specialized hospice palliative care units (HPCUs) has been an important part of national policy to promote hospice palliative care in Korea in the recent decade. However, few studies have sought to identify patterns and barriers for utilizing HPCU over the period of national policy implementation. We aimed to investigate factors related with utilizing HPCU for terminal cancer patients after consultation with a palliative care team (PCT). METHODS We reviewed medical records for 1,028 terminal cancer patients who were referred to the PCT of the National Cancer Center in 2010 and 2014. We compared the characteristics of the patients who decided to utilize HPCU and those who did not. We also analyzed factors influencing choices for a medical institution and reasons for not selecting an HPCU. RESULTS The patients' mean age was 61.0 ± 12.2, with lung cancer patients (24.3%) comprising the largest percentage of these patients. The percentage of referred patients who utilized an HPCU was 53.9% in 2014, increasing from 44.6% in 2010. Older age and awareness of terminal illness were found to be positively associated with utilization of an HPCU. The most common reason for not selecting an HPCU was "refusing hospice facility" (34.9%), followed by "near death," "poor accessibility to an HPCU," and "caregiving problems." CONCLUSION Compared to 2010, HPCU utilization by terminal cancer patients increased in 2014. Improving awareness of terminal condition among patients and family members and earlier discussion of end-of-life care would be important to promote utilization of HPCU.
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Affiliation(s)
- So-Jung Park
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Jeong Nam
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yoon Jung Chang
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yong-Jae Lee
- Department of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Hyun Jung Jho
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
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20
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Adusumilli P, Nayak L, Viswanath V, Digumarti L, Digumarti RR. Palliative care and end-of-life measure outcomes: Experience of a tertiary care institute from South India. South Asian J Cancer 2018; 7:210-213. [PMID: 30112344 PMCID: PMC6069332 DOI: 10.4103/sajc.sajc_257_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Desisting from disease directed treatment in the past weeks of life is a quality criterion in oncology service. Patients with advanced cancer have unrealistic expectations from chemotherapy and hold on to it as a great source of hope. Many oncologists continue futile and unnecessary treatments, instead of conveying to the patients the lack of benefit, resulting in delayed referral for palliative care (PC). MATERIALS AND METHODS This is a retrospective analysis of case records from June 2014 to December 2015. The primary objective was to study, how far back in time terminally ill cancer patients received definitive cancer directed therapy (DCDT). Apart from patient demographics, the diagnosis, stage, and details of DCDT, and death were captured. PC referral data were recorded. DCDT to death was taken as treatment-free interval (TFI). Analysis was performed using IBM SPSS Statistics for Windows, Version 20. RESULTS A total of 292 case records were evaluated. Seventy-three had inadequate treatment details. Hence, 219 records were analyzed. PC referral was done in 78.5% of patients. Only best supportive care (BSC) without any DCDT was given in 27 patients. The most common reason for BSC was a poor performance status in 92.5%. The median time from PC referral till death was 43.5 days (range: 1-518 days). Chemotherapy was the most common DCDT in 52.9% of patients. The median time from DCDT and death was 49 days (range: 0-359 days). Cervical and ovarian cancers patients had the longest TFI; shortest in unknown primary. Most patients died at home (70.4%). Patients receiving PC preferred home or hospice as place of death. Of the 80 patients given hospice care, 39 (36.5%) died in the hospice. CONCLUSION While DCDT needs to be started at the right time, it should also be discontinued when futile. Early involvement of the PC team, even while patients are on DCDT makes the transition smoother and more meaningful.
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Affiliation(s)
- Praveen Adusumilli
- Department of Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Andhra Pradesh, India
| | - Lingaraj Nayak
- Department of Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Andhra Pradesh, India
| | - Vidya Viswanath
- Department of Palliative Medicine, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Andhra Pradesh, India
| | - Leela Digumarti
- Department of Gynaec Oncology, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Andhra Pradesh, India
| | - Raghunadha Rao Digumarti
- Department of Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Andhra Pradesh, India
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21
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Habibi A, Wu SP, Gorovets D, Sansosti A, Kryger M, Beaudreault C, Chung WY, Shelton G, Silverman J, Lowy J, Kondziolka D. Early Palliative Care for Patients With Brain Metastases Decreases Inpatient Admissions and Need for Imaging Studies. Am J Hosp Palliat Care 2018; 35:1069-1075. [DOI: 10.1177/1049909118765405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Early encounters with palliative care (PC) can influence health-care utilization, clinical outcome, and cost. Aim: To study the effect of timing of PC encounters on brain metastasis patients at an academic medical center. Setting/Participants: All patients diagnosed with brain metastases from January 2013 to August 2015 at a single institution with inpatient and/or outpatient PC records available for review (N = 145). Design: Early PC was defined as having a PC encounter within 8 weeks of diagnosis with brain metastases; late PC was defined as having PC after 8 weeks of diagnosis. Propensity score matched cohorts of early (n = 46) and late (n = 46) PC patients were compared to control for differences in age, gender, and Karnofsky Performance Status (KPS) at diagnosis. Details of the palliative encounter, patient outcomes, and health-care utilization were collected. Results: Early PC versus late PC patients had no differences in baseline KPS, age, or gender. Early PC patients had significantly fewer number of inpatient visits per patient (1.5 vs 2.9; P = .004), emergency department visits (1.2 vs 2.1; P = .006), positron emission tomography/computed tomography studies (1.2 vs 2.7, P = .005), magnetic resonance imaging scans (5.8 vs 8.1; P = .03), and radiosurgery procedures (0.6 vs 1.3; P < .001). There were no differences in overall survival (median 8.2 vs 11.2 months; P = .2). Following inpatient admissions, early PC patients were more likely to be discharged home (59% vs 35%; P = .04). Conclusions: Timely PC consultations are advisable in this patient population and can reduce health-care utilization.
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Affiliation(s)
- Akram Habibi
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
- Department of Neurosurgery, NYU Medical School, New York, USA
| | - S. Peter Wu
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | - Daniel Gorovets
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | - Alexandra Sansosti
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
- Department of Neurosurgery, NYU Medical School, New York, USA
| | - Marc Kryger
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | - Cameron Beaudreault
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | - Wei-Yi Chung
- Department of Population Health, NYU Medical School, New York, USA
| | - Gary Shelton
- Department of Medicine, NYU Medical School, New York, USA
| | - Joshua Silverman
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
- Department of Neurosurgery, NYU Medical School, New York, USA
| | - Joseph Lowy
- Department of Medicine, NYU Medical School, New York, USA
| | - Douglas Kondziolka
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
- Department of Neurosurgery, NYU Medical School, New York, USA
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22
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Khang PS, Wang SE, Liu ILA, Watson HL, Koyama SY, Huynh DN, Lee JS, Nguyen HQ. Impact of Inpatient Palliative Care on Quality of End-of-Life Care and Downstream Acute and Postacute Care Utilization. J Palliat Med 2018; 21:913-923. [PMID: 29649400 DOI: 10.1089/jpm.2017.0275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Additional evidence is needed regarding the impact of inpatient palliative care (IPC) on the quality of end-of-life care and downstream utilization. AIM Examine the effects of IPC on quality of end-of-life care and acute and postacute care use in a large integrated system. DESIGN Retrospective cohort design. SETTING/PARTICIPANTS Adult decedents from January 1, 2012, to December 31, 2014, who had at least one hospitalization at 11 Kaiser Permanente Southern California medical centers in the 12 months before death and not hospitalized for a trauma-related condition or receiving home-based PC or hospice were included in the cohort. MATERIALS AND METHODS Inverse probability of treatment weighting of propensity scores was used to compare outcomes between patients exposed to IPC (n = 3742) and controls (n = 12,755) who never received IPC before death. RESULTS Patients who received IPC were more likely to enroll in home-based PC or hospice (69% vs. 43%) and were less likely to die in a hospital (15% vs. 29%) or intensive care (2% vs. 9%) compared with controls (all, p < 0.001). IPC exposure was associated with higher risk for rehospitalization (HR: 1.18, 95% CI 1.11-1.25) and more frequent emergency department visits (RR: 1.16, 95% CI 1.07-1.26) with no increase in postacute care use compared with controls. Stratified analyses showed that IPC effects on acute care utilization were dependent on code status. CONCLUSION IPC exposure was associated with higher enrollment in home-based PC/hospice and more deaths at home. The increased acute care utilization by the IPC group may reflect persistent confounding by indication.
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Affiliation(s)
- Peter S Khang
- 1 Geriatric Palliative Care, Kaiser Permanente Southern California, Los Angeles Medical Center , Los Angeles, California
| | - Susan E Wang
- 2 Geriatric Palliative Care, Kaiser Permanente Southern California, West Los Angeles Medical Center , Los Angeles, California
| | - In-Lu Amy Liu
- 3 Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California
| | - Heather L Watson
- 4 Complete Care Programs, Kaiser Permanente Southern California , Pasadena, California
| | - Sandra Y Koyama
- 5 Internal Medicine, Kaiser Permanente Southern California , Baldwin Park, California
| | - Dan N Huynh
- 6 Hospital Medicine, Home Care Services, Kaiser Permanente Southern California , Pasadena, California
| | - Janet S Lee
- 3 Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California
| | - Huong Q Nguyen
- 3 Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California
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23
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Fukui N, Golabi P, Otgonsuren M, de Avila L, Bush H, Younossi ZM. Hospice care in Medicare patients with primary liver cancer: the impact on resource utilisation and mortality. Aliment Pharmacol Ther 2018; 47:680-688. [PMID: 29314093 DOI: 10.1111/apt.14484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/01/2017] [Accepted: 12/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few studies have assessed the impact of hospice care in patients with primary liver cancer. AIM To examine the determinants of hospice care and its effects on resource utilisation and survival among Medicare beneficiaries with primary liver cancer. METHODS We utilised the Surveillance, Epidemiology and End result Registry (SEER) database from 2002 to 2009 for this cross-sectional study. A total of 3385 patients with primary liver cancer were included. We used logistic regression to discern variables associated with hospice and Cox proportional hazards models to evaluate one-year mortality risk. RESULTS Compared to patients who enrolled in a hospice, those patients who did not, were younger, non-White and sicker (P < .05 for all). Half of all patients with primary liver cancer died within six months of diagnosis, and one-year mortality was similar in both groups (P = .413). After adjusting for baseline characteristics [age at diagnosis, race, disease severity, tumour stage and treatment], shorter time to hospice care was associated with reduced mortality (HR per day: 0.99 [95% CI, 0.98-0.99]). Older age, decompensated cirrhosis and advanced tumours stage were associated with decreased time to hospice, while Asian/Pacific Islander race and history of radiosurgery were associated with increased time to hospice (all P < .05). Hospitalisations were more costly for those who never enrolled in a hospice compared to hospice enrollees (median $31 607 [$18 394-$54 254] vs $22 316 [$13 741-$36 170], P < .0001). CONCLUSIONS Hospice enrolment of patients with primary liver cancer provides survival and resource utilisation benefits. Some clinical and demographic factors may represent barriers to hospice enrolment. Further studies are needed to fully understand these barriers in patients with primary liver cancer.
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Affiliation(s)
- N Fukui
- Department of Medicine, Center For Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA
| | - P Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - M Otgonsuren
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - L de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - H Bush
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Z M Younossi
- Department of Medicine, Center For Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
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Wilson A, Martins-Welch D, Williams M, Tortez L, Kozikowski A, Earle B, Attivissimo L, Rosen L, Pekmezaris R. Risk Factor Assessment of Hospice Patients Readmitted within 7 Days of Acute Care Hospital Discharge. Geriatrics (Basel) 2018; 3:geriatrics3010004. [PMID: 31011052 PMCID: PMC6371090 DOI: 10.3390/geriatrics3010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 11/16/2022] Open
Abstract
Factors surrounding readmission rates for hospice patients within seven days are still relatively unknown. The present study specifically investigates the seven-day readmission rate of patients newly discharged to hospice, and the predictive factors associated with readmission for this population. In a retrospective case-control study, we seek to identify potential predictors by comparing the characteristics of patients discharged to hospice and readmitted within one week to patients who were not readmitted. Cases (n = 46) were patients discharged to home hospice and readmitted to the hospital within seven days. Controls (n = 117) were patients discharged to home hospice and not readmitted to the hospital within seven days. Significant risk factors for readmission within seven days were found to be: age (p < 0.01), race (p < 0.001), language (p < 0.001), and insurance (p < 0.001). Further study of these predictors may identify opportunities for interventions that address patient and family concerns that may lead to readmission.
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Affiliation(s)
- Anthony Wilson
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| | - Diana Martins-Welch
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| | - Myia Williams
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
- Correspondence: ; Tel.: +1-516-600-1479
| | - Leanne Tortez
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| | - Andrzej Kozikowski
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| | - Bridget Earle
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| | | | - Lisa Rosen
- Feinstein Institute for Medical Research, Manhasset, NY 11030, USA;
| | - Renee Pekmezaris
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
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25
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Phongtankuel V, Meador L, Adelman RD, Roberts J, Henderson CR, Mehta SS, del Carmen T, Reid M. Multicomponent Palliative Care Interventions in Advanced Chronic Diseases: A Systematic Review. Am J Hosp Palliat Care 2018; 35:173-183. [PMID: 28273750 PMCID: PMC5879777 DOI: 10.1177/1049909116674669] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Many patients live with serious chronic or terminal illnesses. Multicomponent palliative care interventions have been increasingly utilized in patient care; however, it is unclear what is being implemented and who is delivering these interventions. OBJECTIVES To (1) describe the delivery of multicomponent palliative care interventions, (2) characterize the disciplines delivering care, (3) identify the components being implemented, and (4) analyze whether the number of disciplines or components being implemented are associated with positive outcomes. DESIGN Systematic review. STUDY SELECTION English-language articles analyzing multicomponent palliative care interventions. OUTCOMES MEASURED Delivery of palliative interventions by discipline, components of palliative care implemented, and number of positive outcomes (eg, pain, quality of life). RESULTS Our search strategy yielded 71 articles, which detailed 64 unique multicomponent palliative care interventions. Nurses (n = 64, 88%) were most often involved in delivering care, followed by physicians (n = 43, 67%), social workers (n = 33, 52%), and chaplains (n = 19, 30%). The most common palliative care components patients received were symptom management (n = 56, 88%), psychological support/counseling (n = 52, 81%), and disease education (n = 48, 75%). Statistical analysis did not uncover an association between number of disciplines or components and positive outcomes. CONCLUSIONS While there has been growth in multicomponent palliative care interventions over the past 3 decades, important aspects require additional study such as better inclusion of key groups (eg, chronic obstructive pulmonary disease, end-stage renal disease, minorities, older adults); incorporating core components of palliative care (eg, interdisciplinary team, integrating caregivers, providing spiritual support); and developing ways to evaluate the effectiveness of interventions that can be readily replicated and disseminated.
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Affiliation(s)
- Veerawat Phongtankuel
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - Lauren Meador
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - Ronald D. Adelman
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | | | | | - Sonal S. Mehta
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - Tessa del Carmen
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - M.C. Reid
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
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26
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Mullen MM, Divine LM, Porcelli BP, Wilkinson-Ryan I, Dans MC, Powell MA, Mutch DG, Hagemann AR, Thaker PH. The effect of a multidisciplinary palliative care initiative on end of life care in gynecologic oncology patients. Gynecol Oncol 2017; 147:460-464. [DOI: 10.1016/j.ygyno.2017.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/23/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
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27
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Bužgová R, Sikorová L, Kozáková R, Jarošová D. Predictors of Change in Quality of Life in Patients With End-Stage Disease During Hospitalization. J Palliat Care 2017; 32:69-76. [PMID: 28884618 DOI: 10.1177/0825859717724687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Currently, there are no studies aimed at evaluating the quality of life (QoL) of patients with end-stage disease during hospitalization and the factors that influence it. AIM The aim of the research was to identify predictors of change in the QoL of patients hospitalized due to advanced stage of disease. METHODS The sample consisted of 140 patients with end-stage disease who were hospitalized on this account. For evaluation of QoL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used. The Hospital Anxiety and Depression Scale and Karnofsky Performance Status questionnaires were used for the assessment of mental and functional status. For the evaluation of predictors of negative change in QoL, a logistic regression analysis was used. RESULTS During hospitalization, there was a significant deterioration in the scores given for all domains of the functional QLQ-C30 scale, but not the symptomatic scale. Predictors of change in overall QoL detected were marital status, improved functional status, and depression detected on admission to hospital. Gender and age were found to be protective factors against deterioration in overall QoL. CONCLUSION Sociodemographic characteristics and mental and functional status may be associated with change in QoL of patients with end-stage disease during hospitalization.
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Affiliation(s)
- Radka Bužgová
- 1 Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lucie Sikorová
- 1 Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Radka Kozáková
- 1 Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Darja Jarošová
- 1 Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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28
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DiMartino LD, Weiner BJ, Hanson LC, Weinberger M, Birken SA, Reeder-Hayes K, Trogdon JG. Inpatient Palliative Care Consultation and 30-Day Readmissions in Oncology. J Palliat Med 2017; 21:62-68. [PMID: 28772084 DOI: 10.1089/jpm.2017.0172] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prior research indicates that hospice and palliative care delivered in outpatient settings are associated with reduced hospital readmissions for cancer patients. However, little is known about how inpatient palliative care affects readmissions in oncology. OBJECTIVE To examine associations among inpatient palliative care consultation, hospice use (discharge), and 30-day readmissions among patients with solid tumor cancers. METHODS We identified all live discharges from a large tertiary cancer hospital between 2010 and 2016. Palliative care consult data were abstracted from medical charts and linked to hospital encounter data. Propensity scores were used to match palliative care consult to usual care encounters. Modified Poisson regression models estimated adjusted relative risk (aRR) and 95% confidence intervals (CI) of 30-day readmissions and hospice discharge. We compared predicted probabilities of readmission for palliative care consultation with hospice discharge, without hospice discharge, and usual care. RESULTS Of 8085 eligible encounters, 753 involved a palliative care consult. The likelihood of having a 30-day readmission did not differ between palliative care consult and usual care groups (p > 0.05). However, the palliative care consult group was more likely than usual care to have a hospice discharge (aRR = 4.09, 95% CI: 3.07-5.44). The predicted probability of 30-day readmission was lower when palliative care consultation was combined with hospice discharge compared to usual care or consultation with discharge to nonhospice postacute care (p < 0.001). CONCLUSIONS The effect of inpatient palliative care on readmissions in oncology is largely driven by hospice enrollment. Strategies that combine palliative care consultation with hospice discharge may decrease hospital readmissions and improve cancer care quality.
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Affiliation(s)
- Lisa D DiMartino
- 1 Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,5 RTI International, Research Triangle Park, North Carolina
| | - Bryan J Weiner
- 2 Departments of Global Health and Health Services, University of Washington , Seattle, Washington
| | - Laura C Hanson
- 3 Division of Geriatric Medicine, Palliative Care Program, Cecil Sheps Center for Health Services Research, The University of North Carolina, Chapel Hill, North Carolina
| | - Morris Weinberger
- 1 Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Sarah A Birken
- 1 Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Katherine Reeder-Hayes
- 4 Lineberger Comprehensive Cancer Center, Department of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Justin G Trogdon
- 1 Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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29
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Agarwal R, Epstein AS. Palliative care and advance care planning for pancreas and other cancers. Chin Clin Oncol 2017; 6:32. [PMID: 28705009 PMCID: PMC6119222 DOI: 10.21037/cco.2017.06.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 05/27/2017] [Indexed: 12/25/2022]
Abstract
The principles of palliative care are fundamental to support and treat the physical, mental, and psychosocial health of patients living with pancreatic cancer. In addition to its proven advantages to help manage disease-related symptoms, improve accurate illness understanding, and enhance the quality of life and survival outcomes for patients with advanced disease, the inclusion of palliative care principles (whether by a specialist or by the primary oncology team) with standard oncologic care strengthens timely and quality advance care planning (ACP). The primary objective of this review article is to underscore the significant value of palliative care integration and ACP in oncology, including but not limited to care at the end of life, with a particular focus on its relevance to patients with advanced pancreatic cancer.
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Affiliation(s)
- Rajiv Agarwal
- Department of Medicine, Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Andrew S Epstein
- Gastrointestinal Oncology Service, Palliative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA.
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30
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Zhang H, Barysauskas C, Rickerson E, Catalano P, Jacobson J, Dalby C, Lindvall C, Selvaggi K. The Intensive Palliative Care Unit: Changing Outcomes for Hospitalized Cancer Patients in an Academic Medical Center. J Palliat Med 2017; 20:285-289. [DOI: 10.1089/jpm.2016.0225] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Haipeng Zhang
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Constance Barysauskas
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth Rickerson
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Paul Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Carol Dalby
- Department of Quality Improvement, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kathy Selvaggi
- Department of Palliative Care, Butler Health System, Butler, Pennsylvania
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Effects of hospital palliative care on health, length of stay, and in-hospital mortality across intensive and non-intensive-care units: A systematic review and metaanalysis. Palliat Support Care 2017; 15:741-752. [PMID: 28196551 DOI: 10.1017/s1478951516001164] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Hospital palliative care has been shown to improve quality of life and optimize hospital utilization for seriously ill patients who need intensive care. The present review examined whether hospital palliative care in intensive care (ICU) and non-ICU settings will influence hospital length of stay and in-hospital mortality. METHOD A systematic search of CINAHL/EBSCO, the Cochrane Library, Google Scholar, MEDLINE/Ovid, PubMed, and the Web of Science through 12 October 2016 identified 16 studies that examined the effects of hospital palliative care and reported on hospital length of stay and in-hospital death. Random-effects pooled odds ratios and mean differences with corresponding 95% confidence intervals were estimated. Heterogeneity was measured by the I 2 test. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to assess the overall quality of the evidence. RESULTS Of the reviewed 932 articles found in our search, we reviewed the full text of 76 eligible articles and excluded 60 of those, which resulted in a final total of 16 studies for analysis. Five studies were duplicated with regard to outcomes. A total of 18,330 and 9,452 patients were analyzed for hospital length of stay and in-hospital mortality from 11 and 10 studies, respectively. Hospital palliative care increased mean hospital length of stay by 0.19 days (pooled mean difference = 0.19; 95% confidence interval [CI 95%] = -2.22-2.61 days; p = 0.87; I 2 = 95.88%) and reduced in-hospital mortality by 34% (pooled odds ratio = 0.66; CI 95% = 0.52-0.84; p < 0.01; I 2 = 48.82%). The overall quality of evidence for both hospital length of stay and in-hospital mortality was rated as very low and low, respectively. SIGNIFICANCE OF RESULTS Hospital palliative care was associated with a 34% reduction of in-hospital mortality but had no correlation with hospital length of stay.
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32
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Salomon S, Chuang E, Bhupali D, Labovitz D. Race/Ethnicity as a Predictor for Location of Death in Patients With Acute Neurovascular Events. Am J Hosp Palliat Care 2017; 35:100-103. [PMID: 28056515 DOI: 10.1177/1049909116687258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Site of death is an important quality indicator for patients with terminal illness. Racial and ethnic disparities exist in the quality of end-of-life care. This study explores the site of death of patients admitted for and dying of complications of acute neurovascular events in a hospital network in an urban, low-income, predominantly minority community. METHODS This is a retrospective cohort study of patients admitted to 1 of 3 general hospitals that are part of an academic medical center in Bronx, New York, with the diagnosis of acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage who died during the index admission or were discharged with hospice services. The main outcome was location of death (palliative care inpatient unit [IPU] at the medical center or hospice services at discharge vs death on any other IPU). RESULTS A total of 655 patients admitted with acute neurovascular events from January 1, 2009, to March 1, 2015, died or were discharged with hospice services and were included in the analysis. Of those patients, 238 (36.3%) were black, 233 (35.5%) were Hispanic, and 184 (28.1%) were white. A total of 178 (24.4%) died on the palliative care unit or were discharged with hospice services, including 55 black patients (23.1%), 52 (28.3%) white patients, and 53 (22.7%) Hispanic patients. These differences were not statistically significant, even when controlling for confounders. CONCLUSION This study did not show a difference in site of death in our institution by race or ethnicity, which is considered an important quality end-of-life care metric.
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Affiliation(s)
- Say Salomon
- 1 Department of Family and Social Medicine, Palliative Care Service, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth Chuang
- 1 Department of Family and Social Medicine, Palliative Care Service, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Deepa Bhupali
- 2 Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Labovitz
- 2 Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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33
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Zalenski RJ, Jones SS, Courage C, Waselewsky DR, Kostaroff AS, Kaufman D, Beemath A, Brofman J, Castillo JW, Krayem H, Marinelli A, Milner B, Palleschi MT, Tareen M, Testani S, Soubani A, Walch J, Wheeler J, Wilborn S, Granovsky H, Welch RD. Impact of Palliative Care Screening and Consultation in the ICU: A Multihospital Quality Improvement Project. J Pain Symptom Manage 2017; 53:5-12.e3. [PMID: 27720791 DOI: 10.1016/j.jpainsymman.2016.08.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/12/2016] [Accepted: 08/03/2016] [Indexed: 11/22/2022]
Abstract
CONTEXT There are few multicenter studies that examine the impact of systematic screening for palliative care and specialty consultation in the intensive care unit (ICU). OBJECTIVE To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria. METHODS In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was used to estimate the conditional probability of receiving a PCC and to balance important covariates. For patients with and without PCCs, outcomes studied were as follows: 1) change to "do not resuscitate" (DNR), 2) discharge to hospice, 3) 30-day readmission, 4) hospital length of stay (LOS), 5) total direct hospital costs. RESULTS In 405 patients with positive screens, 161 (40%) who received a PCC were compared to 244 who did not. Patients receiving PCCs had higher rates of DNR-adjusted odds ratio (AOR) = 7.5; 95% CI 5.6-9.9) and hospice referrals-(AOR = 7.6; 95% CI 5.0-11.7). They had slightly lower 30-day readmissions-(AOR = 0.7; 95% CI 0.5-1.0); no overall difference in direct costs or LOS was found between the two groups. When patients receiving PCCs were stratified by time to PCC initiation, early consultation-by Day 4 of admission-was associated with reductions in LOS (1.7 days [95% CI -3.1, -1.2]) and average direct variable costs (-$1815 [95% CI -$3322, -$803]) compared to those who received no PCC. CONCLUSION Receiving a PCC in the ICUs was significantly associated with more frequent DNR code status and hospice referrals, but not 30-day readmissions or hospital utilization. Early PCC was associated with significant LOS and direct cost reductions. Providing PCC early in the ICU should be considered.
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Affiliation(s)
- Robert J Zalenski
- Wayne State University, Detroit, Michigan, USA; Tenet Healthcare, Dallas, Texas, USA.
| | | | | | | | | | | | | | | | | | | | | | | | - Maria Teresa Palleschi
- DMC Harper Hospital, Detroit, Michigan, USA; American Hospital Dubai, United Arab Emirates
| | - Mona Tareen
- American Hospital Dubai, United Arab Emirates
| | | | | | - Julie Walch
- Detroit Medical Center, Detroit, Michigan, USA
| | | | - Sonali Wilborn
- Detroit Medical Center, Detroit, Michigan, USA; Seasons Hospice and Palliative Care, Madison Heights, Michigan, USA
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Thygeson NM, Wang M, O'Riordan D, Pantilat SZ. Self-Reported California Hospital Palliative Care Program Composition, Certification, and Staffing Level Are Associated with Lower End-of-Life Medicare Utilization. J Palliat Med 2016; 19:1281-1287. [DOI: 10.1089/jpm.2016.0176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N. Marcus Thygeson
- Department of Healthcare Quality and Affordability, Blue Shield of California, San Francisco, California
| | - Meinong Wang
- School of Public Health, Yale University, New Haven, Connecticut
| | - David O'Riordan
- Department of Medicine, University of California, San Francisco, California
| | - Steven Z. Pantilat
- Department of Hospital Medicine, University of California, San Francisco, California
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Lindley LC. The Effect of Pediatric Palliative Care Policy on Hospice Utilization Among California Medicaid Beneficiaries. J Pain Symptom Manage 2016; 52:688-694. [PMID: 27693902 PMCID: PMC5107325 DOI: 10.1016/j.jpainsymman.2016.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/27/2016] [Accepted: 05/21/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT California implemented pediatric palliative care legislations that allowed children to receive curative and supportive care from diagnosis of a life-threatening serious illness in 2010. Palliative care policies may improve access to hospice care as children near end of life. OBJECTIVES The aim of this study was to examine the effect of the palliative care policy on hospice utilization for children and their families was investigated. METHODS Using 2007 and 2010 California Medicaid data, a difference-in-difference analysis was conducted to analyze hospice use (i.e., hospice enrollment, hospice length of stay) changes for children who resided in pediatric policy counties relative to those who did not. The sample of children in California who died with a life-threatening serious illness in 2007 and 2010 equaled 979 children. RESULTS More than 10% of children enrolled in hospice care with an average of less than 3 days of hospice care. The palliative care policy did not have any effect on hospice enrollment. However, the policy was positively associated with increasing days in hospice care (incidence rate ratio = 5.61, P < 0.05). The rate of hospice length of stay increased by a factor of 5.61 for children in palliative care counties compared with children unaffected by the policy. CONCLUSION The pediatric palliative care policy was associated with longer lengths of stay in hospice once the children were enrolled. Policies promoting palliative care are critical to ensuring access to hospice care for children.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA.
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Shimada N, Ishiki H, Iwase S, Chiba T, Fujiwara N, Watanabe A, Kinkawa J, Nojima M, Tojo A, Imai K. Cancer Transitional Care for Terminally Ill Cancer Patients Can Reduce the Number of Emergency Admissions and Emergency Department Visits. Am J Hosp Palliat Care 2016; 34:831-837. [PMID: 27413014 DOI: 10.1177/1049909116658641] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Emergency admissions and emergency department visits (EAs/EDVs) have been used as quality indicators of home care in terminally ill cancer patients. We established a cancer transitional care (CTC) program to monitor and manage terminally ill cancer patients receiving care at home. The purpose of this study was to evaluate the effectiveness of CTC by the frequency of EAs/EDVs. METHODS In a retrospective chart review, we identified 133 patients with cancer admitted to our department, of whom 56 met study eligibility criteria. The CTC consisted of at least 1 or more following components: (1) a 24-hour hotline for general physicians or home care nurses to reach hospital-based physicians, (2) periodic phone calls from an expert hospital-based oncology nurse to home care medical staff, and (3) reports sent to our department from home care medical staff. The primary outcome variable was the frequency of EAs/EDVs. RESULTS There were 32 EAs/EDVs and 69 planned admissions during the observation period. In the last 30 days of life, 16 patients (28.6%) had 1 EA/EDV and none had multiple EAs/EDVs. Compared with previous studies, our study found a similar or lower frequency of EAs/EDVs. CONCLUSION Our findings suggest that the implementation of CTC reduces the number of EAs/EDVs by replacing them with planned admissions. Further prospective studies to evaluate CTC are warranted.
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Affiliation(s)
- Naoki Shimada
- 1 Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroto Ishiki
- 1 Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoru Iwase
- 1 Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Tsukuru Chiba
- 1 Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Noriko Fujiwara
- 1 Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Aya Watanabe
- 1 Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Junya Kinkawa
- 1 Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masanori Nojima
- 2 Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Arinobu Tojo
- 1 Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,3 Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kohzoh Imai
- 4 Center for Antibody and Vaccine Therapy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Mercadante S, Adile C, Caruselli A, Ferrera P, Costanzi A, Marchetti P, Casuccio A. The Palliative-Supportive Care Unit in a Comprehensive Cancer Center as Crossroad for Patients' Oncological Pathway. PLoS One 2016; 11:e0157300. [PMID: 27332884 PMCID: PMC4917085 DOI: 10.1371/journal.pone.0157300] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/26/2016] [Indexed: 11/19/2022] Open
Abstract
Aim The aim of this study was to assess how an admission to an acute palliative-supportive care unit (APSCU), may influence the therapeutic trajectory of advanced cancer patients. Methods A consecutive sample of advanced cancer patients admitted to APCU was assessed. The following parameters were collected: patients demographics, including age, gender, primary diagnosis, marital status, and educational level, performance status and reasons for and kind of admission, data about care-givers, recent anticancer treatments, being on/off treatment or uncertain, the previous care setting, who proposed the admission to APSCU. Physical and psychological symptoms were evaluated at admission and at time of discharge. The use of opioids was also recorded. Hospital staying was also recorded. At time of discharge the parameters were recorded and a follow-up was performed one month after discharge. Results 314 consecutive patients admitted to the APSCU were surveyed. Pain was the most frequent reason for admission. Changes of ESAS were highly significant, as well as the use of opioids and breakthrough pain medications (p <0.0005). A significant decrease of the number of “on therapy” patients was reported, and concomitantly a significant number of “off-therapy” patients increased. At one month follow-up, 38.9% patients were at home, 19.7% patients were receiving palliative home care, and 1.6% patients were in hospice. 68.5% of patients were still living. Conclusion Data of this study suggest that the APSCU may have a relevant role for managing the therapeutic trajectory of advanced cancer patients, limiting the risk of futile and aggressive treatment while providing an appropriate care setting.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care Unit and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
- * E-mail: ;
| | - Claudio Adile
- Anesthesia and Intensive Care Unit and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | | | - Patrizia Ferrera
- Anesthesia and Intensive Care Unit and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Andrea Costanzi
- Department of Oncology, Hospital Sant’Andrea, University of Rome, Rome, Italy
| | - Paolo Marchetti
- Department of Oncology, Hospital Sant’Andrea, University of Rome, Rome, Italy
| | - Alessandra Casuccio
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
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Chang HT, Chen CK, Lin MH, Chou P, Chen TJ, Hwang SJ. Readmissions in Cancer Patients After Receiving Inpatient Palliative Care in Taiwan: A 9-Year Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2016; 95:e2782. [PMID: 26937907 PMCID: PMC4779004 DOI: 10.1097/md.0000000000002782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Few studies have reported on readmissions among cancer patients receiving inpatient palliative care (IPC). This study investigated readmissions in cancer patients after their first discharge from IPC in Taiwan from 2002 to 2010.This study was a secondary data analysis using information from the National Health Insurance Database in Taiwan from 2002 to 2010. We included subjects ≥20 years old diagnosed with malignant neoplasms who were listed in the registry of catastrophic illness. Patients diagnosed with cancer before January 1, 2002 or who had ever been admitted to an inpatient hospice palliative care unit before the study period were excluded. Readmission was defined as hospital readmission at least once after discharge from first admission to IPC until mortality or the end of the study period.A total of 42,022 patients who met the inclusion criteria were identified. The majority of these patients were male (60.4%). The mean age of cancer diagnosis was 64.0 ± 14.4 years for men and 64.5 ± 14.7 years for women. The mean age at first hospice ward admission was 65.2 ± 14.2 years for men and 65.9 ± 14.9 years for women. During their first admission to IPC, 59.2% patients died, and the median stay of first IPC admission was 8.0 days. Among those discharged alive from their first admission to IPC, 64.9% were readmitted, and 19.4% of these patients were readmitted on the same day of discharge. From first IPC discharge until mortality, 54.8% of patients were readmitted once, 23.9% were readmitted twice, 9.9% were readmitted 3 times, and 11.5% were readmitted 4 or more times. Being male, having a higher insurance premium level, having a longer length of stay during first IPC admission, being admitted to a teaching hospital, or being admitted to a tertiary hospital increased the adjusted hazard ratio for readmission.We found that terminal cancer patients in Taiwan received relatively late referrals for first admission to IPC and experienced a high rate of readmission after first discharge from IPC. Policies to improve hospice palliative care referrals and decrease readmissions should be considered.
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Affiliation(s)
- Hsiao-Ting Chang
- From the Department of Family Medicine, Taipei Veterans General Hospital, and School of Medicine and Institute of Public Health and Community Medicine Research Center, National Yang-Ming University (H-TC); Department of Radiology, Taipei Veterans General Hospital, and School of Medicine and Institute of Clinical Medicine, National Yang-Ming University (C-KC); Department of Family Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University (M-HL and S-JH); Institute of Public Health and Community Medicine Research Center, National Yang-Ming University (PC); and Department of Family Medicine, Taipei Veterans General Hospital, and School of Medicine and Institute of Hospital and Health Care Administration, National Yang-Ming University (T-JC), Taipei, Taiwan
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Shah N, Homel P, Breznay J. Use of Medical Devices in Hospice for Symptom Management. Am J Hosp Palliat Care 2015; 33:929-934. [PMID: 26275782 DOI: 10.1177/1049909115600856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Home health services in the United States(US) have been on a rise. Hospice patients cope with diverse physical and pain symptoms; medical devices are used for symptom management to improve their quality-of-care at end-of-life. OBJECTIVE Using the National Home and Hospice Care Survey (NHHCS), the study summarizes medical device use for symptom management and tracks various demographic variables for home hospice patients. METHODS A cross-sectional analysis of data using the 2007 NHHCS was conducted. There were 4733 hospice discharges which corresponded to 2,505,011 individuals in US with sampling weights. The data was analyzed using chi square tests and confounding factors adjusted with logistic regression. RESULTS Eighty-nine percent of hospice discharges were evaluated for pain at first assessment. The regression model for pain at first assessment was significantly associated with use of patient controlled analgesia (OR = 1.82, 95% CI = 1.28, 2.59) and urinary catheters (OR = 1.16, 95% CI = 1.02, 1.33). Patient with dyspnea were associated with significant use of oxygen (OR = 3.00, 95% CI = 2.64, 3.40) and metered dose inhaler (OR = 2.43, 95% CI = 1.92, 3.07). There was negligible use of total parenteral nutrition (TPN) noted in the study. CONCLUSION In conclusion, the study highlights medical device use in home hospice care for end-of-life symptom management. It noted the significant use of IV infusion pumps and patient controlled analgesia. Conversely, there is little use of TPN or CPAP in patients with anorexia or dyspnea. While missing data on critical symptom evaluations regrettably raises questions about the validity of the study, the NHHCS serves as an important reservoir of data on the growing population of home hospice patients.
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Affiliation(s)
- Nidhi Shah
- Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Peter Homel
- Maimonides Medical Center, Brooklyn, NY, USA
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O'Connor NR, Moyer ME, Behta M, Casarett DJ. The Impact of Inpatient Palliative Care Consultations on 30-Day Hospital Readmissions. J Palliat Med 2015; 18:956-61. [PMID: 26270277 DOI: 10.1089/jpm.2015.0138] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Inpatient palliative care consultations have been shown to reduce acute care utilization by reducing length of stay, but less is known about their impact on subsequent costs including hospital readmissions. OBJECTIVE The study's objective was to examine the impact of inpatient palliative care consultations on 30-day hospital readmissions to a large urban academic medical center. METHODS The hospital's electronic medical record system was used to identify all live discharges between August 2013 and November 2014. After adjusting for a propensity score, readmission rates were compared between palliative care and usual care groups. RESULTS Of the 34,541 hospitalizations included in the study, 1430 (4.1%) involved a palliative care consult. After adjusting for the propensity score, patients seen by palliative care had a lower 30-day readmission rate-adjusted odds ratio (AOR) 0.66, 0.55-0.78; p<0.001. Adjusted rates were 10.3% (95% confidence interval [CI] 8.9%-12.0%) for palliative care and 15.0% (95% CI 14.4%-15.4%) for usual care. Among all palliative care patients, consultations that involved goals of care discussions were associated with a lower readmission rate (AOR 0.36, 0.27-0.48; p<0.001), but consultations involving symptom management were not (AOR 1.05, 0.82-1.35; p=0.684). CONCLUSIONS Palliative care palliative care consultations facilitate goals discussions, which in turn are associated with reduced rates of 30-day readmissions.
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Affiliation(s)
- Nina R O'Connor
- 1 Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Mary E Moyer
- 1 Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Maryam Behta
- 2 Program for Clinical Effectiveness and Quality Improvement, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - David J Casarett
- 1 Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
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van Vliet LM, Epstein AS. Current state of the art and science of patient-clinician communication in progressive disease: patients' need to know and need to feel known. J Clin Oncol 2014; 32:3474-8. [PMID: 25267758 DOI: 10.1200/jco.2014.56.0425] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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